Evaluating access to brentuximab in elderly patients with Hodgkin lymphoma.
Authors: Erin Michele Mobley, Yujia Li, Yi Guo, Dejana Braithwaite, John R. Wingard, Raymond Mailhot Vega
Journal: Journal of Clinical Oncology (2023)

e18663 Background: Despite the high survival associated with Hodgkin lymphoma (HL), established disparities exist both in survival for Black and Hispanic patients and their access to consolidative treatments like radiotherapy as demonstrated using large, population-based databases. Elderly patients with HL face inferior survival compared to younger patients. Brentuximab is an approved second line therapy for those patients with refractory/relapsed HL. We examined whether there were inequities in receipt of treatment among those diagnosed with HL in a contemporary cohort receiving frontline doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), allowing for evaluation of targeted therapy. Methods: Data from Surveillance Epidemiology and End-Results (SEER) linked to Medicare claims were used to identify individuals diagnosed with HL from 2008 to 2017 who received frontline treatment with ABVD using applicable Healthcare Common Procedure Coding System codes. We examined differences in associations with receipt of brentuximab following ABVD within two years of diagnosis. Descriptive statistics were used to characterize the sample. We ran univariable and multivariable logistic regression models (producing adjusted odds ratios, aOR and 95% confidence intervals, CI) predicting treatment with brentuximab. Multivariable models were adjusted for age at diagnosis, sex, race/ethnicity, stage, insurance at diagnosis, and geographic location. Results: A total of 2,651 people diagnosed with HL were identified, 2,007 (76%) of which survived two years and 1,475 (56%) were still alive at last follow-up in 2019. Mean age at diagnosis was 69 years (SD: 12.4), most were men (N = 1,457, 55%), non-Hispanic White (N = 2,050, 77%), Hispanic (N = 291, 11%), or non-Hispanic Black (N = 220, 8%), diagnosed with stage I or II disease (N = 1,591, 60%), and received radiotherapy (N = 663, 23%) or brentuximab (N = 181, 7%) within two years of diagnosis. On univariable analysis, race and ethnicity did not have a statistically significant association with receipt of brentuximab as adjuvant treatment within two years of diagnosis. On multivariable analysis, individuals without insurance at diagnosis (aOR 1.54; 95% CI 1.02, 2.30) or those diagnosed with stage III or IV disease (aOR 2.04; 95% CI 1.04, 2.98) were more likely to receive brentuximab as adjuvant treatment within two years of diagnosis, after adjusting for the variables described above. Conclusions: Although we cannot definitively say that receipt of brentuximab within two years of diagnosis following ABVD is due to relapse, we posit that this can be used as a proxy for relapse. Our analysis did not demonstrate that race and ethnicity rose to traditional levels of statistical significance regarding associations with decreased odds of receiving brentuximab. In multivariable analysis, patients without insurance or diagnosed with stage III or IV disease were more likely to receive brentuximab.